Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

Powell, Nick; Knight, Hannah; Dunn, Jason M.; Saxena, Vishal; Mawdsley, Joel; Murray, Charles; Hoare, J; Teare, Julian; McNair, Alistair

doi:10.1055/s-0030-1256174

Cited by 26 publications

(17 citation statements)

References 10 publications

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“…Several prior studies have evaluated the utility of TI intubation in a variety of settings, with potential benefits ranging from confirmation of complete colonoscopy to identifying small bowel pathology. [14][15][16][17] However, most such studies were conducted more than 10 years ago and none previously evaluated successful TI intubation in relation to colonoscopy quality measures. Meanwhile, it has been suggested that the process of attempting TI intubation may deflect folds and uncover previously hidden lesions, 18 which might be particularly important given that colonoscopy is less effective at preventing right-sided cancers than those on the left.…”

Section: Discussionmentioning

confidence: 99%

Terminal ileum intubation is not associated with colonoscopy quality measures

Leiman

Jawitz

Lin

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Intubation of the terminal ileum (TI) demonstrates a complete colonoscopy, but its clinical value during screening exams is unknown. We aimed to determine whether TI intubation during screening colonoscopy is associated with colonoscopy quality measures or identifies subclinical pathology. Methods: We performed a retrospective cohort study examining average-risk screening colonoscopies performed at an academic health system between July 2016 and October 2017. Data were extracted from an internal colonoscopy quality registry and the electronic health record. Appropriate statistical tests were used for group comparisons, to correlate TI intubation rate (TIIR) with measures of colonoscopy quality and to examine factors associated with the likelihood of TI intubation. Results: There were 7799 colonoscopies performed with adequate prep quality by 28 gastroenterologists. Most patients were female (56.4%) with a median age of 58. The median TIIR was 37.0%, with significant variability among physicians (2-93%). The detection rates for all polyps, adenomas, and sessile serrated polyps were 62.1%, 45.5%, and 7.2%, respectively, and none correlated with TIIR. Intubation of the TI was associated with significantly longer withdrawal times. In a random 10% sample of cases with TI intubation, no clinically significant pathology was found. Conclusions: There is wide variability in TIIR among endoscopists. Except to provide photodocumentation of exam extent when other images may be difficult to obtain, the lack of correlation between TI intubation and meaningful clinical outcomes together with the associated time costs suggest routine TI intubation during screening colonoscopy may not be warranted.

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Section: Discussionmentioning

confidence: 99%

Terminal ileum intubation is not associated with colonoscopy quality measures

Leiman

Jawitz

Lin

et al. 2020

J of Gastro and Hepatol

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“…49 The reliability of photodocumentation of the caecum in demonstrating completion has been questioned with ileal photodocumentation advocated as more accurate 50. Biopsy of the ileum may additionally be useful in confirming completion but can be technically difficult, comes with extra costs and has some associated risks, so it is not recommended as a standard of practice 51–53…”

Section: The Standardsmentioning

confidence: 99%

Expert opinions and scientific evidence for colonoscopy key performance indicators

Rees

Bevan

Zimmermann-Fraedrich

et al. 2016

Gut

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Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.

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“…While admittedly, there is not strong data to demonstrate the accuracy of images of the caecum to definitively document colonoscopy completion, that practice should be encouraged. Pictures of the ileum have been shown to be more definitive,36 however, routine ileal intubation for this purpose is not recommended 37. Explicit documentation examination extant in the postprocedure report should be required.…”

Section: Quality Assurance In Colonoscopymentioning

confidence: 99%

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

Robertson

Kaminski

Bretthauer

2015

Gut

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Screening for colorectal cancer has been proven to be effective in reducing colorectal cancer incidence and mortality. While the precise benefit of screening exclusively by colonoscopy is not yet known, unarguably, the exam is central to the success of any screening programme. The test affords the opportunity to detect and resect neoplasia across the entire large bowel and is the definitive examination when other screening tests are positive. However, colonoscopy is invasive and often requires sedation as well as extensive bowel preparation, all of which puts the patient at risk. Furthermore, the test can technically be demanding and, unarguably, there is variation in how it is performed. This variation in performance has now been definitively linked to important outcome measures. For example, interval cancers are more common in low adenoma detectors as compared with high adenoma detectors. This review outlines the most current thinking regarding the effectiveness of colonoscopy as a screening tool. It also outlines key concepts to optimise its performance through robust quality assurance programmes and high-quality training.

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Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

Cited by 26 publications

References 10 publications

Terminal ileum intubation is not associated with colonoscopy quality measures

Terminal ileum intubation is not associated with colonoscopy quality measures

Expert opinions and scientific evidence for colonoscopy key performance indicators

Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

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